Fear of Painful Sex: Understanding Vaginismus as a Phobia Response
Nandini Bhatia

Nandini Bhatia

Mar 26Vaginismus

Fear of Painful Sex: Understanding Vaginismus as a Phobia Response

What is Vaginismus?

Vaginismus involves recurrent or persistent involuntary spasms of the vagina’s outer muscles, preventing the penetration of any object (penis, finger, tampon, menstrual cup, gynaecologist’s speculum etc.), despite the person's definite desire to do so

It is understood as the body’s protective response that causes an involuntary contraction of the pelvic floor muscles, causing the entrance of the vagina to close. It is an uncontrollable response generally rooted in fear. It does not necessarily affect one’s ability to get aroused or enjoy other types of sexual contact. 

Vaginismus is classified as primary or secondary. It is primary vaginismus if it’s a lifelong condition i.e. if the individual has never been able to have penetration of any kind, despite desiring so. This is often discovered during one’s first attempt at penetrative sex, inserting a tampon, or the first time a pelvic examination is attempted by a doctor. It is secondary vaginismus if painless intercourse has been experienced in the past but the individual is no longer able to have it. This can be triggered by particularly stressful life events, emotional distance created by marital conflicts, childbirth trauma and injuries, or health conditions such as pelvic inflammatory diseases, infections, endometriosis etc.

It has been associated with high levels of disturbance for those affected and can have a profound impact on how a woman feels about herself, on her partner, and on their relationship. 


Vaginismus as a Phobic or Fear Response

A phobia can be simply described as an excessive and irrational fear reaction. One may experience a deep sense of dress or panic when they encounter the specific source of fear. 

Pelvic floor reactions such as an involuntary spasm of the pelvic floor has been observed as a part of the body’s wider defence reaction to threat and stress, in individuals both with and without vaginismus. Vaginismus is a phobic, involuntary, and reflexive response to protect the individual against actual, perceived, or anticipated harm from vaginal penetration - of any kind. Fear of pain is the most significant factor observed in women coming to Proactive For Her for vaginismus treatment. The root of this fear may be in having heard stories of and expecting penetration to be painful, inaccurate sex education, excessive and unbalanced exposure to stories of sexual assault etc. This can result in hyper-vigilance, negative perception of any sexual cues, and avoidance of sex. Hence, the phobia for some individuals is not due to the experience of actual pain but in the anticipation of pain. 

Women who experience high stress or perceive to have high levels of stress are considered vulnerable to vaginismus. Anxiety and being prone to anxiety has also been identified as a risk factor for vaginismus. Women with vaginismus may also report specific phobias related to bleeding, bodily injury, childbirth and show an unwillingness to engage in penetration if even the possibility of pain presents itself. 

Some women with vaginismus have also been found to respond to sexual stimuli with more disgust and show increased pelvic floor tension. This response could possibly be due to beliefs around sex and masturbation being shameful or wrong. This conditioning is often seen in women who have grown up with overly restrictive upbringing (in which sexuality was considered a taboo subject), restrictive religious teaching resulting in unhealthy or sex negative messages, and inadequate or incorrect sex education. Hence, in such cases, the underlying fear may not be of the pain but of the resultant shame or consequence arising out of penetration. 

Vaginismus must not be confused with the fear, phobia or anxiety around and of sex as it is a fear response to penetration of any object and is characterised by the desire to insert it but not being able to due to the muscle spasm experienced at the time. Beliefs around sex and sexual intercourse can contribute to underlying beliefs of vaginismus that can get triggered at the time of attempting penetration. 

Vaginismus and the muscle spasm must not be understood purely as a dysfunctional response but should be normalised as a healthy functional response to the threat that protects the individual from real or perceived potential harm. 


Vaginismus as a Psychological and Mental Health Concern

Vaginismus is a psychosomatic condition, which means that it is borne out of an interaction between the mind and the body. Traditionally, vaginismus was understood as a physical concern characterised by the vaginal spasm. With new research, studies have found that it’s actually affected by multiple factors, beyond just the physical symptoms. It’s important to focus on deeper cognitive (mental) and emotional meanings behind the physical symptoms. The factors that contribute to vaginismus are understood to lie on a spectrum and are understood as a combination of physical to psychological, influenced by relationships and one’s cultural context. Different blends of these factors will contribute to it in unique ways to each set of partners experiencing vaginismus. 


Some of these factors include: 

  • Beliefs around penetrative sex being painful or underlying fears about tissue damage or the hymen being torn, due to misinformation about the body and acts of sex
  • Beliefs around sex and masturbation being shameful or wrong including overly restrictive upbringing (in which sexuality was considered a taboo subject), repressive religious teaching resulting in unhealthy or sex negative messages, and inadequate sex education,
  • Negative beliefs around sexual organs including the vagina being too small or having a penis aversion
  • Excessive fears around negative consequences of sex including painful childbirth, unwanted pregnancy, sexually transmitted diseases etc. 
  • Experiences of pain around genitals including painful periods, vaginal injuries or surgeries 
  • Painful first sexual experiences 
  • Traumatic events including past emotional, physical and sexual abuse or being a witness of violence or abuse, or exposure to unsafe touch experiences, or excessive exposure to stories of sexual assault 
  • Having a general anxiety disorder that is characterised by hyper-vigilance, catastrophic thinking and an excessive need for control as well as development of perfectionism
  • Relationship dynamics, particularly a lack of emotional safety with one’s partner (due to mistrust, lack of commitment or emotional detachment) which could create anxiety about being vulnerable.

    As the aforementioned factors underlying vaginismus are primarily psychological, emotional, relational, and cultural in nature, it makes vaginismus a mental health or psychological concern as well. 


Moving Forward 

One shouldn’t have to live out their life in perpetual fear of pain, threat or the consequence of sex. Every individual has a right to a safe, protected, respectful, pain-free, and pleasurable sexual experience. Unfortunately, vaginismus remains enveloped in taboo, shame, embarrassment, or sheer ignorance, leaving women often without a name for their experiences, resigned to endure their condition silently. Vaginismus is a treatable condition provided a holistic and well-rounded approach is applied. The essential components of an effective vaginismus treatment plan are the following: 

  • Psycho-sexual therapy to address the underlying psychological and mental health factors of vaginismus. In the presence of a trauma-informed mental health expert, one must gain insight into the excessive fear and phobia that may be contributing to vaginismus as well as heal their related past trauma. 
  • Mind and body relaxation done through mindfulness, breathing, and exercises as advised by a trained yoga professional to ease their stress and anxiety. 
  • Pelvic floor exercises as advised by a trained pelvic health physiotherapist to target the pelvic floor muscles to gain better control of them and their general movement. It also helps to ease the tension in the pelvic floor. This also aids with vaginal training or dilation wherein the movement and stretching would decrease the pain and allow the muscles to relax. 
  • Vaginal training using vaginal dilators can be extremely helpful for the mental, visual, and physical adaptation to penetration and to refute the belief that penetration is painful. Dilators are cylindrical shaped devices which come in various sizes. They are used to help open and stretch the tissues in the vaginal canal and release pain points, along with building the mental and emotional threshold to accept penetration. 
  • Partner relationship and intimacy to build better communication and understanding between partners, provide a space for them to vent and feel supported, along with initiating partnered physical exercises aimed at improving emotional and physical connection. In some cases, couples counselling may be needed to address some deeper running issues. 
  • Support network with other women with vaginismus to address feelings of isolation that come with the condition, experience empathy and support. 



Vaginismus is a lot more common than we all think. Proactive For Her’s award winning, multi-faceted Vaginismus Healing Program has a multidisciplinary team to treat vaginismus holistically and supportively. If you suspect someone you know might be dealing with vaginismus, reach out to us to schedule an initial screening call and gain more information.